IMPRESSIVE NUTRITIONAL EFFICACY NEWS

Interview with Professor Alessandro Laviano at ESPEN 2018, by Meg Blogg Marquardt, Nestlé Health Science. Professor Laviano is Associate professor of Internal Medicine at the Department of Clinical Medicine, Sapienza University of Rome, Italy.

From ESPEN 2018, Madrid September 1-4 September.

MB: Good morning Professor Laviano. We are here on the last day in Madrid at the ESPEN Congress, how’s the meeting been for you?

AL: The meeting has been extremely interesting on the educational part and of course also on the scientific part. I mean, there is now very, very good evidence which has been shared during this congress about the role of nutrition in order to improve the efficacy of treatment. I was particularly interested about the information I got here about the role of nutrition in cancer patients. This has been really fascinating because we have now very robust epidemiological data showing that, believe it or not, nutrition can influence the survival of cancer patients. There were data about patients with colorectal cancers, stage 3, receiving adjuvant therapy and nutrition was able to improve the survival, reduce the recurrence and, you know, I was really impressed because they were doing these kind of statistical calculations and they were seeing that if all cancer patients, all colorectal cancer patients, Stage 3 receiving adjuvant therapy would follow these nutritional recommendation what believe would be 38% less death. 38% less death in oncology is huge.

MB: It’s astounding.

AL: It’s huge. I mean it’s…I don’t recall any drug which can have such an effect. So I mean, I think that in the future there will be more and more role for nutrition not only oncology, this was of course something extraordinary, but I think for all the patients with acute disease, with chronic disease.

MB: I talked earlier to your colleague about chronic renal disease, if people pay attention to nutrition in some of the chronic illnesses that can really not only improve their quality of life but maybe their outcome?

AL: Well, actually, I was surprised because, you know, many, many times when you discuss with your colleagues who are not actually expert in nutrition they always say, okay, yes, nice but you are only improving their body weight and their composition, maybe quality of life. I think that now we can actually really tell these people that by providing nutrition you can improve also the efficacy of treatment and in some way also the survival of these patients. And there was another interesting aspect because during this conference there was always these words coming out which were ‘windows of opportunity’. And this was particularly true when we were discussing about nutrition in surgical patients because for  decades we thought nutrition is important in these patients because we want to reduce post operative complications. But now there are data showing that even short periods of intervention in the perioperative period can significantly improve the survival for example of cancer patients undergoing surgery. So surgeons should know that if they are not providing nutrition in the perioperative period for the patients they may reduce the chance for these patients not only to have a better post operative outcome but a long term outcome. This is amazing.

MB: So, you are a professor in this area so not everybody has your knowledge and it is complex, and at a meeting like this you have the feeling that everybody’s on board with the concepts. What are the biggest challenges for you day to day in the real world when you are back at the hospital,in the ICU or other departments?

AL: Well, you know, this really, your questions really touches another important aspect because there were actually showing the data of one of the ESPEN projects which is called Nutrition Day Oncology which has collected data from more than 9000 cancer patients all over the world, and they were showing that although we believe that nutrition, and particularly some specific nutrients, like omega 3 fatty acids, like branch chain amino acids, and so on, but we have data showing that they are affective during treatment. In the real world these are not used, they’re only used for the targeted phase when we know that the efficacy could be extremely limited, which really means that there is a huge discrepancy between what is the evidence and what is the real practice. So the next goal of the society and everyone who is involved in nutrition is really to spread the knowledge. Maybe also trying to find the collaboration of patients associations Blogg.

MB: That makes sense. I have a controversial question that I don’t like to ask people of your stature. Do we always need hard evidence for these kind of topics where we all know we need a certain combination of macro and micronutrients to live in health? Do we need this dialogue in illness with hard evidence?

AL: Well, you know, unfortunately we live in a world in which, for example, reimbursement, inclusion in guidelines, is based on evidence based medicine. So we may discuss maybe a week about should we really need, you know, a prospective randomised controlled trial with 10,000 patients with a proper placebo group, but then in the end when you go to the Ministry of Health and you want that our treatment is reimbursed they will ask for these kind of evidence.

MB: And I know the Hippocratic oath of course is you don’t want to do any harm, so therefore the evidence is supporting your best intentions. It’s very challenging in the field of nutrition.

AL: Absolutely yes, but you know what, I think that we should rely more on big data. I’m pretty sure there are so many hospitals and centres which have a lot of data in their database, in their computers, because maybe they’re collecting enormous amounts of data. Now the only thing is that they people working in these centres has to find maybe a PhD student, a younger student, a resident, who wants to sit down at a computer and try to collect the data from these database and try to see what happens. I think that the data already there and we just need to find the strategy to collect them and then to spread.

MB: Well, that’s a fantastic take home message. I think that’s particularly pertinent for the intensive care where they do some indirect calorimetry and it’s certainly something that’s an action point for out listeners. Thank you very much Professor Laviano.

AL: Thank you, thank you so much.